Provider Demographics
NPI:1104280650
Name:KAUFMAN, SHANNON (DC)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 ROY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4219
Mailing Address - Country:US
Mailing Address - Phone:206-285-1068
Mailing Address - Fax:
Practice Address - Street 1:557 ROY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4219
Practice Address - Country:US
Practice Address - Phone:206-285-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60631494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor